Brachial plexus injury following spinal surgery

A review

Juan S. UribeDepartments of Neurological Surgery,

Search for other papers by Juan S. Uribe in
jns
Google Scholar
PubMedClose
 M.D.
,
Jaya KollaTampa General Hospital;

Search for other papers by Jaya Kolla in
jns
Google Scholar
PubMedClose
 M.D.
,
Hesham OmarTampa General Hospital;
Department of Cardiology, Cairo University, Cairo, Egypt

Search for other papers by Hesham Omar in
jns
Google Scholar
PubMedClose
 M.D.
,
Elias DakwarDepartments of Neurological Surgery,

Search for other papers by Elias Dakwar in
jns
Google Scholar
PubMedClose
 M.D.
,
Naomi AbelNeurology,

Search for other papers by Naomi Abel in
jns
Google Scholar
PubMedClose
 M.D.
,
Devanand MangarTampa General Hospital;
Neurology,

Search for other papers by Devanand Mangar in
jns
Google Scholar
PubMedClose
 M.D.
, and
Enrico CamporesiNeurology,
Surgery,
Anesthesiology, and
Molecular Pharmacology and Physiology, University of South Florida;

Search for other papers by Enrico Camporesi in
jns
Google Scholar
PubMedClose
 M.D.
View More View Less
Page Range:
552–558
Volume/Issue:
Volume 13: Issue 4
DOI link:
https://doi.org/10.3171/2010.4.SPINE09682
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $384.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
Click here for subscription options

  • Purchase Now

    USD  $45.00

  • Spine - 1 year subscription bundle (Individuals Only)

    USD  $384.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $624.00
USD  $45.00
USD  $384.00
USD  $624.00
Print or Print + Online Sign in

Object

In the present study, the authors identified the etiology, precipitating factors, and outcomes of perioperative brachial plexus injuries following spine surgery.

Methods

We reviewed all the available literature regarding postoperative/perioperative brachial plexus injuries, with special concern for the patient's position during surgery, duration of surgery, the procedure performed, neurological outcome, and prognosis. We also reviewed the utility of intraoperative electrophysiological monitoring for prevention of these complications.

Results

Patient malpositioning during surgery is the main determining factor for the development of postoperative brachial plexus injury. Recovery occurs in the majority of cases but may require weeks to months of therapy after initial presentation.

Conclusion

Brachial plexus injuries are an increasingly recognized complication following spinal surgery. Proper attention to patient positioning with the use of intraoperative electrophysiological monitoring techniques could minimize injury.

Abbreviations used in this paper:

EMG = electromyographic; MEP = motor evoked potential; SSEP = somatosensory evoked potential.
  • Collapse
  • Expand

Contributor Notes

Address correspondence to: Juan S. Uribe, M.D., Department of Neurosurgery, Tampa General Hospital, 2 Tampa General Circle, Tampa, Florida 33606. email: juansuribe@gmail.com.
  • 1

    Afifi AK, , Kimura J, & Bell WE: Hypothermia-induced reversible polyneuropathy: electrophysiologic evidence of axonopathy. Pediatr Neurol 4:49–53, 1988

    • Search Google Scholar
    • Export Citation
  • 2

    American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies: Practice advisory for the prevention of perioperative peripheral neuropathies: a report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies. Anesthesiology 92:1168–1182, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Balzer JR, , Rose RD, , Welch WC, & Sclabassi RJ: Simultaneous somatosensory evoked potential and electromyographic recordings during lumbosacral decompression and instrumentation. Neurosurgery 42:1318–1325, 1998

    • Search Google Scholar
    • Export Citation
  • 4

    Beatty RM, , McGuire P, , Moroney JM, & Holladay FP: Continuous intraoperative electromyographic recording during spinal surgery. J Neurosurg 82:401–405, 1995

    • Search Google Scholar
    • Export Citation
  • 5

    Ben-David B, & Stahl S: Prognosis of intraoperative brachial plexus injury: a review of 22 cases. Br J Anaesth 79:440–445, 1997

  • 6

    Bose B, , Wierzbowski LR, & Sestokas AK: Neurophysiologic monitoring of spinal nerve root function during instrumented posterior lumbar spine surgery. Spine 27:1444–1450, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Britt B: Complications in Anesthesiology Philadelphia, Lippincott, 1983

  • 8

    Brunette KE, , Hutchinson DO, & Ismail H: Bilateral brachial plexopathy following laparoscopic bariatric surgery. Anaesth Intensive Care 33:812–815, 2005

    • Search Google Scholar
    • Export Citation
  • 9

    Büdinger K: Ueber Lähmungen nach Chloroformnarkosen. Arch Klin Chir 47:121, 1894

  • 10

    Calancie B, , Harris W, , Brindle GF, , Green BA, & Landy HJ: Threshold-level repetitive transcranial electrical stimulation for intraoperative monitoring of central motor conduction. J Neurosurg 95:2 Suppl 161–168, 2001

    • Search Google Scholar
    • Export Citation
  • 11

    Calancie B, , Harris W, , Broton JG, , Alexeeva N, & Green BA: “Threshold-level” multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring. J Neurosurg 88:457–470, 1998

    • Search Google Scholar
    • Export Citation
  • 12

    Chen X, , Sterio D, , Ming X, , Para DD, , Butusova M, & Tong T, et al.: Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deficits. J Clin Neurophysiol 24:281–285, 2007

    • Search Google Scholar
    • Export Citation
  • 13

    Chin P, & Poole G: Bilateral brachial plexus injury during laparoscopic sigmoid colectomy. ANZ J Surg 73:86–88, 2003

  • 14

    Chung I, , Glow JA, , Dimopoulos V, , Walid MS, , Smisson HF, & Johnston KW, et al.: Upper-limb somatosensory evoked potential monitoring in lumbosacral spine surgery: a prognostic marker for position-related ulnar nerve injury. Spine J 9:287–295, 2009

    • Search Google Scholar
    • Export Citation
  • 15

    Clausen E: Postoperative (“anesthetic”) paralysis of the brachial plexus. Surgery 12:933–942, 1942

  • 16

    Cooper DE, , Jenkins RS, , Bready L, & Rockwood CA Jr: The prevention of injuries of the brachial plexus secondary to malposition of the patient during surgery. Clin Orthop Relat Res 228:33–41, 1988

    • Search Google Scholar
    • Export Citation
  • 17

    Delorme EJ: Hypothermia. Anaesthesia 11:221–231, 1956

  • 18

    Edgcombe H, , Carter K, & Yarrow S: Anaesthesia in the prone position. Br J Anaesth 100:165–183, 2008

  • 19

    Eggspuehler A, , Sutter MA, , Grob D, , Jeszenszky D, , Porchet F, & Dvorak J: Multimodal intraoperative monitoring (MIOM) during cervical spine surgical procedures in 246 patients. Eur Spine J 16:Suppl 2 S209–S215, 2007

    • Search Google Scholar
    • Export Citation
  • 20

    Frei FJ, , Ryhult SE, , Duitmann E, , Hasler CC, , Luetschg J, & Erb TO: Intraoperative monitoring of motor-evoked potentials in children undergoing spinal surgery. Spine 32:911–917, 2007

    • Search Google Scholar
    • Export Citation
  • 21

    Garriques H: Anesthesia-paralysis. Am J Med Sci 113:81–89, 1897

  • 22

    Goettler CE, , Pryor JP, & Reilly PM: Brachial plexopathy after prone positioning. Crit Care 6:540–542, 2002

  • 23

    Hilibrand AS, , Schwartz DM, , Sethuraman V, , Vaccaro AR, & Albert TJ: Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery. J Bone Joint Surg Am 86:1248–1253, 2004

    • Search Google Scholar
    • Export Citation
  • 24

    Jackson L, & Keats AS: Mechanism of brachial plexus palsy following anesthesia. Anesthesiology 26:190–194, 1965

  • 25

    Jones HD: Ulnar nerve damage following general anaesthetic. A case possibly related to diabetes mellitus. Anaesthesia 22:471–475, 1967

    • Search Google Scholar
    • Export Citation
  • 26

    Kamel IR, , Drum ET, , Koch SA, , Whitten JA, , Gaughan JP, & Barnette RE, et al.: The use of somatosensory evoked potentials to determine the relationship between patient positioning and impending upper extremity nerve injury during spine surgery: a retrospective analysis. Anesth Analg 102:1538–1542, 2006

    • Search Google Scholar
    • Export Citation
  • 27

    Kaye A: Classification of nerve injuries. Essential Neurosurgery New York, Churchill Livingstone, 1991. 333–334

  • 28

    Kelleher MO, , Tan G, , Sarjeant R, & Fehlings MG: Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine 8:215–221, 2008

    • Search Google Scholar
    • Export Citation
  • 29

    Kent CD, & Cheney FW: A case of bilateral brachial plexus palsy due to shoulder braces. J Clin Anesth 19:482–484, 2007

  • 30

    Kwaan JH, & Rappaport I: Postoperative brachial plexus palsy. A study on the mechanism. Arch Surg 101:612–615, 1970

  • 31

    Labrom RD, , Hoskins M, , Reilly CW, , Tredwell SJ, & Wong PK: Clinical usefulness of somatosensory evoked potentials for detection of brachial plexopathy secondary to malpositioning in scoliosis surgery. Spine 30:2089–2093, 2005

    • Search Google Scholar
    • Export Citation
  • 32

    Lorenzini NA, & Poterack KA: Somatosensory evoked potentials are not a sensitive indicator of potential positioning injury in the prone patient. J Clin Monit 12:171–176, 1996

    • Search Google Scholar
    • Export Citation
  • 33

    Macdonald DB: Intraoperative motor evoked potential monitoring: overview and update. J Clin Monit Comput 20:347–377, 2006

  • 34

    Maguire J, , Wallace S, , Madiga R, , Leppanen R, & Draper V: Evaluation of intrapedicular screw position using intraoperative evoked electromyography. Spine 20:1068–1074, 1995

    • Search Google Scholar
    • Export Citation
  • 35

    Ngamprasertwong P, , Phupong V, & Uerpairojkit K: Brachial plexus injury related to improper positioning during general anesthesia. J Anesth 18:132–134, 2004

    • Search Google Scholar
    • Export Citation
  • 36

    Nuwer MR, , Dawson EG, , Carlson LG, , Kanim LE, & Sherman JE: Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 96:6–11, 1995

    • Search Google Scholar
    • Export Citation
  • 37

    O'Brien MF, , Lenke LG, , Bridwell KH, , Padberg A, & Stokes M: Evoked potential monitoring of the upper extremities during thoracic and lumbar spinal deformity surgery: a prospective study. J Spinal Disord 7:277–284, 1994

    • Search Google Scholar
    • Export Citation
  • 38

    Parks BJ: Postoperative peripheral neuropathies. Surgery 74:348–357, 1973

  • 39

    Pelosi L, , Lamb J, , Grevitt M, , Mehdian SM, , Webb JK, & Blumhardt LD: Combined monitoring of motor and somatosensory evoked potentials in orthopaedic spinal surgery. Clin Neurophysiol 113:1082–1091, 2002

    • Search Google Scholar
    • Export Citation
  • 40

    Po BT, & Hansen HR: Iatrogenic brachial plexus injury: a survey of the literature and of pertinent cases. Anesth Analg 48:915–922, 1969

  • 41

    Raffan AW: Post-operative paralysis of the brachial plexus. BMJ 2:149, 1950

  • 42

    Schwartz DM, , Drummond DS, , Hahn M, , Ecker ML, & Dormans JP: Prevention of positional brachial plexopathy during surgical correction of scoliosis. J Spinal Disord 13:178–182, 2000

    • Search Google Scholar
    • Export Citation
  • 43

    Sloan TB, , Janik D, & Jameson L: Multimodality monitoring of the central nervous system using motor-evoked potentials. Curr Opin Anaesthesiol 21:560–564, 2008

    • Search Google Scholar
    • Export Citation
  • 44

    Slocum HC, , O'Neal KC, & Allen CR: Neurovascular complications from malposition on the operating table. Surg Gynecol Obstet 86:729–734, 1948

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 2835 555 49
Full Text Views 424 46 1
PDF Downloads 552 67 1
EPUB Downloads 0 0 0